New Initiative Aims to Prevent “Disease” of Mass Incarceration

Is mass incarceration a public health problem? Can the rapid increase in the number of Americans behind bars be understood as a spreading contagion?

A new initiative at the Mailman School will take this approach, placing mass incarceration squarely on the public health agenda for the first time. The Incarceration Prevention Initiative will be co-directed by Drs. Ernest Drucker, adjunct professor of Epidemiology, and SMS Chair Lisa Metsch.

Professor Drucker’s 2011 book, A Plague of Prisons: The Epidemiology of Mass Incarceration in America, argued persuasively that incarceration for many non-violent offenses is an epidemic that profoundly influences many public health outcomes, and that the imprisonment of large populations can be studied using public health tools and addressed with a public health lens.

The publication of Dr. Drucker’s book catalyzed work under development by Dean Fried to create a unified public health analysis of the opportunities for preventing mass incarceration; her effort had already been inspired by initiatives by a number of our faculty.

“This new epidemic,” Dr. Drucker says, “exhibits all the characteristics of an infectious disease—spreading most rapidly by proximity to prior cases.” It is also susceptible, he says, to being studied and understood by the basic public health concepts used for other epidemics, such as analysis of outbreaks, the risk factors for contagion, and mechanisms of transmission.

Beginning in the early 1970’s with America’s War on Drugs and New York State’s Rockefeller drug laws requiring mandatory sentencing for minor drug offenses, the “onset” of the epidemic was rapid. The U.S. prison population skyrocketed from 250,000 in 1970 to 2.5 million by 2009, and the number indirectly affected by incarceration, such as family members (especially children), rose to 30 million within 30 years. Today there are more Americans imprisoned because of nonviolent drug offences in the U.S., than the European Union has in prison for all offenses. There are also more African-American men in prison, on probation, or on parole than were enslaved in the mid-1800s.

Mass incarceration affects a broad spectrum of people, but disproportionately impacts the poor and minorities, where it has becomes an endemic and chronic condition. “Once you get into the prison system,” explains Dr. Drucker, “you get ‘infected,’ for life.” A history of imprisonment also increases your vulnerability to many of features of the ‘disease’ of imprisonment: unemployment, homelessness, chronic illnesses, and premature death—even of the infants of imprisoned parents. In this causal chain, when fathers are incarcerated, their families lose an income; sons experience emotional difficulties and are more likely to leave school, deal drugs, and be jailed, perpetuating the disease from generation to generation. Moreover, released prisoners find many avenues for work and benefits shut off, increasing the likelihood of repeat drug offenses and re-imprisonment.

Further, Dean Fried points out, “The factors that lead members of underrepresented minority groups to be vulnerable to imprisonment are urban public health issues: poverty, poor education, homelessness, dropping out of school, joblessness, mental health problems, substance abuse, and violence. This complex system of issues requires new analysis and approaches to prevention.”

Our yearlong initiative aims to integrate the issue of imprisonment into public health thinking at Mailman in both teaching and research. A team of faculty will work in a small task force to develop new research analysis models to understand imprisonment as a public health issue, evaluate more effective approaches to prevention, and gauge its impact on affected populations. Researchers, Dr. Drucker says, frequently study affected populations without ever asking about prison. “But scratch the surface in New York City,” he says, “and the issue of incarceration is huge. ” At Montefiore Medical Center, when residents asked patients if anyone in the family had ever been arrested or jailed, an astounding 55% said yes.

When public health scholars evaluate the health of populations, Dr. Drucker says, they need to know, for example, that going to prison for drugs worsens the prognosis for drug problems. When researchers are studying a new psychological treatment for anger management in children, they need to consider the humiliation and rage sons experience upon seeing a father taken off to jail.

Through the Incarceration Prevention Initiative, Drs. Drucker and Metsch plan to meet with faculty researchers and organize a series of lectures and symposia for the entire Mailman community. Speakers will range from prosecutors, defense attorneys, and judges to drug treatment experts and trainers who teach police how to intervene in domestic violence incidents. “Researchers in criminal justice work in a parallel world to public health,” Dr. Drucker says. “They look at the same issues of family and risk for illness. We need to integrate the two.”

Engaging students will also be a priority. The Mailman School Association for Public Health Action and Criminal Justice, co-founded by students David Cloud and Shae Cali, is one expression of student interest, with a focus on many of the human rights and social justice issues that are inherent to the U.S. epidemic of mass incarceration.

The Initiative, says Professor Metsch, will culminate in a conference bringing together thought leaders from all disciplines at Mailman and people working on criminal justice issues in our community, city, or country. It will produce a research agenda for new solutions and preventive interventions. “At the end of the day,” says Dr. Metsch, “we’re looking at how we can put a public health lens on this problem of mass incarceration. And, ultimately, we’d like to prevent this intergenerational transmission of involvement in the criminal justice system.”